Risk factors for secondary fractures to percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review

Background Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP. Methods The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software. Results A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty. Conclusion The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.

Development and validation of a one year predictive model for secondary fractures in osteoporosis

The number of osteoporosis-related fractures in the United States is no longer declining. Existing risk-based assessment tools focus on long-term risk. Payers and prescribers need additional tools to identify patients at risk for imminent fracture. We developed and validated a predictive model for secondary osteoporosis fractures in the year following an index fracture using administrative medical and pharmacy claims from the Optum Research Database and Symphony Health, PatientSource. Patients ≥50 years with a case-qualifying fracture identified using a validated claims-based algorithm were included. Logistic regression models were created with binary outcome of a second fracture versus no second fracture within a year of index fracture, with the goal of predicting second fracture occurrence. In the Optum Research Database, 197,104 patients were identified with a case-qualifying fracture (43% commercial, 57% Medicare Advantage). Using Symphony data, 1,852,818 met the inclusion/exclusion criteria. Average patient age was 70.09 (SD = 11.09) and 71.28 (SD = 14.24) years in the Optum Research Database and Symphony data, respectively. With the exception of history of falls (41.26% vs 18.74%) and opioid use (62.80% vs 46.78%), which were both higher in the Optum Research Database, the two populations were mostly comparable. A history of falls and steroid use, which were previously associated with increased fracture risk, continue to play an important role in secondary fractures. Conditions associated with bone health (liver disease), or those requiring medications that impact bone health (respiratory disease), and cardiovascular disease and stroke—which may share etiology or risk factors with osteoporosis fractures—were also predictors of imminent fractures. The model highlights the importance of assessment of patient characteristics beyond bone density, including patient comorbidities and concomitant medications associated with increased fall and fracture risk, in alignment with recently issued clinical guidelines for osteoporosis treatment.

Comparison between Siliceous Concretions from the Ionian Basin and the Apulian Platform Margins (Pre-Apulian Zone), Western Greece: Implication of Differential Diagenesis on Nodules Evolution

Siliceous concretions (nodules), from two different geological settings—the Apulian platform margins in Kefalonia island, and the Ionian Basin in Ithaca, Atokos, and Kastos islands—have been studied both in the field and in the laboratory. Nodule cuttings are mainly characterized by the development of a core, around which a ring (rim) has been formed. Mineralogical study, using X-ray powder diffraction (XRPD) analysis, showed that the rim is usually richer in moganite than the core. Homogeneous concretions, without discernible inner core and outer ring, were observed generally in both settings. Mineralogical analysis of the selected siliceous concretions from Kefalonia island showed the presence mostly of quartz and moganite, while calcite either was absent or participated in a few samples in minor/trace abundances. Moganite was generally abundant in all the samples from Kefalonia island. Concretions from the Ionian Basin showed a variation in the quartz, moganite, and calcite contents. Mineralogical differences were recognized both between the different studied geodynamic settings and internally in the same setting, but with different stages of development. The above-mentioned differential diagenesis on nodules evolution could be related to the presence and/or abundance of stylolites, later fluid flows, restrictions from one area to another due to synchronous fault activity, and the composition of substances dissolved in fluids. Moreover, the development of concretions produced secondary fractures in the surrounding area of the nodule-bearing rocks.

Experimental Investigation on Cyclic Huff-n-Puff with Surfactants Based on Complex Fracture Networks in Water-Wet Oil Reservoirs with Extralow Permeability

The injection from a well to other wells can be difficult in extralow-permeability oil reservoirs. In order to address this issue, a method of cyclic huff-n-puff with surfactants based on complex fracture networks for a single horizontal well was proposed and then investigated in terms of the effects of injection and fracture parameters on the oil recovery in water-wet extralow-permeability models. Firstly, the interfacial tension (IFT) and contact angle with different surfactant concentrations were measured to determine the basic properties of the surfactants. Then, the experiments of huff-n-puff with surfactants at different threshold injection pressures and soaking time were carried out to determine the oil increasing effects and analyze the pore-scale (micropores, mesopores, and macropores) mechanisms by combining the technology of nuclear magnetic resonance (NMR), which showed that the recovery increased with threshold injection pressure mostly in mesopores and macropores, while that increased with soaking time mostly in micropores. Eventually, the experiments of cyclic huff-n-puff based on different fracture distributions were conducted in six plate-fractured models to investigate the effects of surfactants, primary fracture, and secondary fracture on each cycle of huff-n-puff. Cyclic huff-n-puff with surfactants assisted by complex fracture networks including both primary and secondary fractures would bring to a higher oil recovery. However, other methods should be taken after several cycles of huff-n-puff due to the rapid reduction of oil recovery of each cycle. The findings for the proposed method should provide a meaningful guide to the development of extralow-permeability oil reservoirs.

3D Numerical Mineral Mechanical Modeling of Fracture Propagation in Complex Reservoirs Rocks at Microscale

<p>Improved efficiency of hydraulic fracturing (HF) operations in complex reservoir rocks requires producing an extensive network of secondary fractures alongside the main fractures. The goal of the presented research is to find optimal stress-strain conditions yielding the most extensive network of secondary fractures at the microscale. The scope includes integrating results of microstructural characterization of tight gas reservoir rock samples and geomechanics. The study addresses the problem of hydraulic fracture optimization by suggesting stress-strain conditions to maximize fracture branching and, therefore, to optimize the drainage zone. We use a multidisciplinary approach including experimental data obtaining and numerical simulations. The first step is preparing a consistent set of 2D and 3D digital rock (DR) microscale models describing the experimental geometry, mineral composition and spatial distribution of mechanical properties of real rock samples. Geomechanical and petrophysical laboratory testing provide calibration/validation data for the DR models. Lab experiments include compressive and tensile strength testing coupled with digital image correlation, and X-ray computed tomography, 2D scanning electron microscopy coupled with mineralogy mapping. The preparation of DR models involves advanced 2D-to-3D and 3D-to-3D image registration techniques. The second step is a simulation of stress-strain states and fracture propagation in the models. We build simulation grids based on the mineral model and use a commercial mechanical simulator to simulate the fracture propagation at a microscale at given stress conditions. We applied the above approach to one of the most promising gas formations located in West Siberia, Russia. The reservoir rock features low permeability and pore dimensions down to tens of nanometers. Simulations delivered fracture networks for different loading conditions at the microscale. Simulation of typical geomechanical conditions allowed choosing reasonable stress-strain conditions that sustain the highest degree of formation fracturing. The research results may be applied to unconventional plays by increasing the efficiency of HF operation and maximizing production from isolated pore systems via establishing voids connectivity in the near-wellbore zone. The knowledge of the optimal stress-strain state for a near-wellbore zone will set the goal for HF propagation modeling at a wellbore scale. Using the approach, a geomechanical modeler would focus on designing main fractures, sustaining required stress-strain conditions in its vicinity, and thus producing the maximal amount of secondary microfractures. The results novelty is related with the simulation of 3D fracture propagation in highly heterogeneous reservoirs rocks taking into account its void space structure and fabric in geometry closest to real conditions.</p>

Multidisciplinary Approach to Reduce Postoperative Complications and Improve the Activity of Patients With Hip Fracture: A 24-month Follow-up Survey

Background: Many multidisciplinary approaches such as fracture liaison services (FLS) have been introduced in the United Kingdom and Japan and have reduced medical complications and secondary fractures. This study investigated patient outcomes following the introduction of FLS.Methods: Patients who were over 50 years old and experienced fragility hip fractures between January 1, 2015 and December 31, 2017, were enrolled in the study. We divided patients into a control group without FLS (94 patients; mean age: 83.8 years; 21 men and 73 women) and a FLS group (373 patients; mean age: 83.3 years; 69 men and 304 women).Results: The time from injury to surgery decreased significantly from 2.42 days to 1.83 days following the introduction of FLS (p = 0.003). The proportion of patients who underwent surgery within 36 hours of injury also increased significantly in the FLS group (p = 0.014). In the FLS group, a significant decrease was observed in the total number of cases with complications after admission (p = 0.004). Significantly more patients with a Barthel index (BI) of ≥80 were observed in the FLS group at 6 months, 12 months, and 24 months following injury (p = 0.046, 0.018, and 0.048, respectively). Multiple logistic regression analysis revealed that the BI at the time of injury, surgery within 36 hours of injury, and postoperative complications was associated with death within 12 or 24 months after the injury.Conclusions: Our results indicate that FLS contributed to earlier recovery and rehabilitation following surgery and accelerated the rehabilitation of medical complications following admission. Our FLS is expected to improve patient activity and decrease secondary hip fracture in patients who have undergone hip surgery.